Effect of Duration of Symptoms on the Clinical and Functional Outcomes of Lumbar Microdiscectomy: A Randomized Controlled Trial

ObjectivesThe objective is to determine whether the preoperative duration of symptoms can affect the clinical and functional outcomes after microdiscectomy.MethodThis study is a single blind randomized controlled trial with level 1 evidence. From 3 January 2016 to 15 February 2017, 122 adult patients with symptomatic lumbar disc herniation were divided randomly by computer system into three groups were treated by microdiscectomy at 6 weeks, 3 months and 6 months from onset of symptoms respectively. Ninety‐seven patients, age (19–47) years, 42 males and 55 females, were analyzed at the end of this study with 3 years of follow up. Primary outcome measures are Oswestry Disability Index (ODI), Roland‐Morris Questionnaire (RMQ) and Visual Analogue Scale (VAS) for back pain and leg pain. Secondary outcome measures are post‐operative complications, length of hospital stay and time of return to daily activities.ResultsThere was significant difference in VAS for back pain among study groups (P = 0.002) at 2 weeks). There were significant differences in VAS for leg pain among study groups (P < 0.001) at 2 weeks and at 3 months (P = 0.003). There was significant difference in ODI among study groups at 2 weeks, 3, 6 months, 1, 2 and 3 years (P = 0.037 at 2 weeks and P < 0.001 at other periods of assessments) and we found that the mean of ODI in group 6 weeks was better than group 3 months and this was better than group 6 months in all periods of assessment. Group 6 weeks was better than group 3 months and this was better than group 6 months in postoperative improvements regarding RMQ with significant difference at 2 weeks postoperatively (P < 0.001) and at 3 months postoperatively (P < 0.001).ConclusionDuration of preoperative symptoms, in patients with lumbar disc herniation, can affect the clinical and functional outcomes after lumbar microdiscectomy as the shorter duration of symptoms resulted in better postoperative clinical and functional outcomes.     

Synthesis and characterization of novel azo-morphine derivatives for possible use in abused drugs analysis

A new simple and fast spectroscopic method was presented as a new marker for heroin use. Novel azo-morphine derivatives with spectroscopic absorption peaks ranging from 330-470 nm, were synthesized by the coupling of morphine (M) and 6-acetyl morphine (6-AM) with freshly prepared diazonium salt of aniline hydrochloride at 0 degrees C. However, no reaction was observed with codeine under the same reaction conditions. Separation of azo dyes was performed by TLC using tetrahydrofuran and dichloromethane in the ratio 1:1. The chemical structure of the products was established by their microanalysis, NMR, IR, UV-vis, and mass spectroscopies. Electronic absorption and excitation spectra of the dyes were measured in solvents of different polarities. The dyes exhibited positive solvatochromism, i.e., a bathochromic band shift as the solvent polarity is increased. Also, the fluorescence quantum yield was sensitive to the polarity and the pH of the medium. The UV-vis spectroscopy of spiked compounds in human urine samples was also reported. The drugs (M, 6-AM and mixture of both) were coupled with freshly prepared diazonium salt even at very low concentration of the drugs 10(-9)M.     

Surgical Management of Abdominal Aortic Aneurysms: A Lost Art?

Endovascular repair of abdominal aneurysms has become the dominant treatment modality for infrarenal aneurysms. Initial reports showed a constant number of open repairs although there was a shift toward complicated juxtra-renal aneurysms. In the past several years, more aggressive endoluminal approaches and the introduction of fenestrated grafts have appeared to dilute the open aneurysm operating experience. Coupled with work hours restrictions and shorter training paradigms, opportunities for training residents in open repair of abdominal aneurysms are decreasing. We envision that future treatment of complicated aortic aneurysms will likely entail advanced fellowship training in open repair and referral of complicated abdominal aneurysms to tertiary care centers.     

Effect of peripheral electrical stimulation on measures of tooth pain threshold and oral soft tissue comfort in children

The effect of peripheral electrical stimulation on tooth pain threshold and comfort of oral soft tissue was evaluated in 30 children, using a double-blind, crossover, study design. Tooth pain threshold was measured before and after 8 minutes of electrical or sham stimulation. Comfort of oral soft tissue during placement of a rubber dam clamp was evaluated 3 minutes after electrical or sham stimulation was begun. Comfort level was rated by each subject and by the investigator, using a visual analog scale (VAS). Heart rate was measured before and immediately following placement of the clamp. Electrical stimulation significantly increased tooth pain threshold and reduced the cardiovascular stress response without altering comfort levels during placement of the clamp. These findings suggest that peripheral electrical stimulation applied in a pediatric dental setting alters sensory aspects of pain but not affective aspects of comfort.     

An unusual cause of rectal bleeding and intestinal obstruction in a child with peripheral vascular malformations

Vascular malformations of the small bowel are rare yet important causes of abdominal pain and rectal bleeding in children. This report describes a 6-year-old girl with a known history of musculoskeletal vascular anomalies who presented with recurrent abdominal pain and rectal bleeding after seemingly minor trauma. A diagnosis of enteric vascular malformation was established, and the patient was treated by a combined laparoscopic and open approach. This case highlights the fact that in the child with known vascular anomalies who presents with sudden gastrointestinal bleeding and intestinal obstruction, the diagnosis of gastrointestinal vascular anomaly should be suspected, and exploratory laparoscopy should be considered. The current management of enteric vascular anomalies is reviewed, and the differences between vascular malformations and hemangiomas are analyzed.